Hearing loss

Any unilateral adult glue ear, a persistent neck node, or cranial nerve palsies → urgent ENT (nasendoscopy + biopsy)

Mixed/sensorineural component (cochlear involvement) affects management; exclude other conductive causes

ASYMMETRIC sensorineural loss or unilateral tinnitus → exclude a vestibular schwannoma (MRI) — see neurology; sudden SNH

Any sudden sensorineural loss is an emergency; accompanying neurology (ataxia, diplopia) → posterior-circulation stroke;

Any asymmetric/unilateral sensorineural hearing loss → MRI to exclude this; brainstem compression if large

Mastoiditis (post-auricular swelling/erythema pushing the pinna forward), intracranial spread, or a child who is systemi

Persistent/vertical/non-fatiguing nystagmus or other neurology → central cause (posterior fossa) → image

Facial nerve palsy, vertigo, severe headache or meningism = intracranial/labyrinthine complication → urgent ENT/neurosur

Asymmetric/progressive features warrant MRI to exclude a vestibular schwannoma; drop attacks (Tumarkin) risk injury

Multiple fractures of differing ages → must consider BOTH OI and non-accidental injury, assessed carefully

Severe deep pain, granulation tissue in the canal, cranial nerve palsy (esp. facial) in a DIABETIC/immunocompromised pat

UNILATERAL persistent OME in an ADULT → examine the postnasal space to exclude a nasopharyngeal carcinoma obstructing th

Perforation with vertigo/sensorineural loss after trauma → suspect ossicular/inner-ear injury (perilymph fistula) → urge

Central features (HINTS exam suggesting stroke — direction-changing nystagmus, normal head-impulse test, skew deviation)